Claim Reviewer

Location Designation: Hybrid - 3 days per week 

Group Benefit Solutions delivers comprehensive insurance and absence management solutions for mid-sized and large companies. Our work fosters a healthier, happier, and more secure workforce, contributing to New York Life’s legacy of being there when we’re needed most. Here, you'll design, implement, and support these solutions directly impacting employees’ lives. At our core, we provide financial security and peace of mind to people through our absence, accident, disability, voluntary benefits, and life insurance solutions. Click here to learn more about Group Benefits solutions.

This position will be based in Pittsburgh, Dallas, Bethlehem or New York with a hybrid work schedule of three days per week in the office.  

Role Overview:

• Complete quality reviews of internal documentation and systems to determine accuracy of deliverables (e.g. claim or calls).
• Provide guidance and coaching because of quality review findings.
• Professional support role, responsible for specific administrative and/or quality review questions and requests from internal business stakeholder.
• Individuals work under limited supervision.


What You'll Do:

• Quality review deliverables – e.g. such as claim review (Compliance, business or performance guarantee reviews) or coaching – based on job aids, contracts and other SOPs.
• Reviews the accuracy of case processing activities such as: claim payments to ensure compliance and consistency with administrative procedures and guidelines.  
• Executes on appropriate quality methodology by providing consultative services and guidance including quality review methodology, compliance and legal guidelines and business standard references.
• Researches, interprets and responds to inquiries from internal customers or partners (Sales, Account Management or Ops management) regarding product and case-specific issues; such as claim investigation and rebuttals.
• Identifies and communicates review findings that needs to be escalated appropriately.
• Acts as a figure of authority / SME in regard to product knowledge, processes and compliance and legal framework.
• Participates in calibration sessions internally and with business partners including vendors.
• Handles rebuttal requests.
• Manage and/or recommend coaching sessions to address defect and error trends.  
• Demonstrates seasoned knowledge of Group Insurance products and processes.
• Champions GBS Quality Review Program to peers and internal customers.  


What You'll Bring:

• 3+ Group Insured/STD/Absence product experience required
• 5+ years of relevant related work experience preferred
• Experience in quality control / review preferred
• Ability to understand compliance, legal and complex business processes  
• Coaching skills and experience
• Outstanding verbal and written communication
• Forward thinking mindset
• Attention to details, organized, quality and productivity driven
• High School Diploma preferred

It is recommended that all qualified candidates apply to this posting as soon as possible.  Residents of Colorado are hereby notified that the deadline to apply is two weeks from the Posting Date listed above.

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Pay Transparency

Salary range: $57,000-$81,500 

Overtime eligible: Nonexempt 

Discretionary bonus eligible: Yes 

Sales bonus eligible: No 

Actual base salary will be determined based on several factors but not limited to individual’s experience, skills, qualifications, and job location. Additionally, employees are eligible for an annual discretionary bonus. In addition to base salary, employees may also be eligible to participate in an incentive program.

Actual base salary within that range will be determined by several components including but not limited to the individual's experience, skills, qualifications, and job location. In addition to base salary, employees may also be eligible to participate in an incentive program.

Our Benefits 

We provide a full package of benefits for employees – and have unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs. Based on feedback from our employees, we continue to refine and add benefits to our offering, so that you can flourish both inside and outside of work. Click here to discover more about our comprehensive benefit options or visit our NYL Benefits Site.

Our Diversity Promise 

We believe in a diverse workforce because it is our mission to advocate for the financial security and success of people in every community. This is why diversity, equity, and inclusion (DEI) are guiding principles that are embedded in our brand and our culture. Click here to learn more about how we have been recognized for our leadership.

Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by the Foundation. We're proud that due to our mutuality, we operate in the best interests of our policy owners. To learn more about career opportunities at New York Life, please visit the Careers page of www.NewYorkLife.com.

​Job Requisition ID: 93085 

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